Peo in Interest of Gregor

• Court: Colorado Court of Appeals
• Decided: October 23, 2025
• Docket: 25CA1401
• Status: Unpublished

Opinion

25CA1401 Peo in Interest of Gregor 10-23-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1401 Pueblo County District Court No. 25MH30064 Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Joshua Allen Gregor,

Respondent-Appellant.

ORDER AFFIRMED

Division V Opinion by JUDGE PAWAR Freyre and Yun, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced October 23, 2025

Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 Respondent, Joshua Allen Gregor, appeals the district court

order authorizing staff at the Colorado Mental Health Hospital in

Pueblo (CMHHIP) to medicate him involuntarily. We affirm.

I. Background

¶2 Gregor was admitted to CMHHIP after being found

incompetent to stand trial on criminal charges. According to the

affidavit and testimony of Dr. Hareesh Pillai, his treating physician,

Gregor has a history of mental illness and was previously admitted

to CMHHIP in 2021. He is currently diagnosed with psychosis —

not otherwise specified.

¶3 Upon his most recent admission to CMHHIP, Gregor exhibited

paranoia, delusions, hallucinations, agitation, pressured speech,

and hyper-religious behavior. He was involuntarily medicated on

an emergency basis after he became agitated, made verbal threats,

clenched his fists, “postured toward” staff, and refused oral

medication. The State then petitioned for a six-month order

permitting the involuntary administration of Seroquel (up to 800 mg

daily), Depakote (up to 4000 mg daily), and Zyprexa (up to 40 mg

daily only for acute agitation or if Gregor refused oral medications).

1 ¶4 At the evidentiary hearing, Dr. Pillai testified that an

involuntary medication order was warranted under Medina because

(1) Gregor is incompetent to effectively participate in treatment

decisions; (2) the requested medications are necessary to prevent

significant and likely long-term deterioration in his mental health

and to prevent the likelihood that he would pose a serious risk of

harm to others; (3) no less intrusive treatment alternative is

available; and (4) Gregor’s prognosis without treatment is so

unfavorable that any bona fide and legitimate interest he has in

refusing treatment must yield to the State’s interests in his health

and the safety of others in the institution. See People v. Medina,

705 P.2d 961, 973 (Colo. 1985). The district court found Dr. Pillai’s

testimony credible and persuasive and adopted his opinions.

¶5 Gregor also testified, objecting to taking the requested

medications because (1) a 600 mg dose of Seroquel makes him tired

in the morning; (2) Depakote causes mild fatigue, numbness in his

right leg, and slight tremors; and (3) Zyprexa causes joint pain and

skin discomfort.

¶6 The district court concluded that Dr. Pillai’s affidavit and

testimony provided clear and convincing evidence for each Medina

2 element. It authorized CMHHIP staff to administer all requested

medications.

II. Discussion

¶7 On appeal, Gregor challenges only the sufficiency of the

evidence regarding the fourth Medina element — whether his need

for treatment is sufficiently compelling to override his bona fide and

legitimate interest in refusing treatment. See id. He argues that

because the district court found that the State had not presented

clear and convincing evidence that treatment was necessary to

prevent harm to others, it gave disproportionate weight to the

State’s interests over his interest in refusing Depakote and Zyprexa.

We conclude that the record amply supports the district court’s

findings and legal conclusion on this element.

A. Standard of Review and Legal Authority

¶8 When a patient challenges the sufficiency of the evidence

supporting the district court’s findings on any of the Medina

elements, we review the record as a whole and, viewing it in the

light most favorable to the State, determine whether the evidence is

sufficient to support the court’s decision. People in Interest of

Ramsey, 2023 COA 95, ¶ 23. We review the court’s conclusions of

3 law de novo and defer to its findings of fact if supported by evidence

in the record. People v. Marquardt, 2016 CO 4, ¶ 8. We also defer

to the district court’s resolution of evidentiary conflicts and its

determinations of witness credibility, the weight of the evidence,

and the inferences to be drawn from it. See People in Interest of

R.C., 2019 COA 99M, ¶ 7. A physician’s testimony alone may

constitute clear and convincing evidence. See People v. Pflugbeil,

834 P.2d 843, 846-47 (Colo. App. 1992).

¶9 In assessing whether a patient’s need for treatment is

sufficiently compelling to override any legitimate interest in refusal,

a court must determine (1) “whether the patient’s refusal is bona

fide and legitimate” and, if so, (2) “whether the prognosis without

treatment is so unfavorable that the patient’s personal preference

must yield to the legitimate interests of the state in preserving the

life and health of the patient placed in its charge and in protecting

the safety of those in the institution.” Medina, 705 P.2d at 974.

B. Sufficient Evidence of Fourth Medina Element

¶ 10 The district court found that (1) Gregor had a bona fide and

legitimate interest in refusing medication based on his alleged side

effects; and (2) Gregor’s prognosis without treatment was so

4 unfavorable that his interest must yield to the State’s interests in

preserving his health and in protecting the safety of those in

CMHHIP. Only the court’s second finding is challenged in this

appeal. The record provides ample evidence for this finding.

¶ 11 As to the State’s interests, Dr. Pillai testified that he

remembered Gregor from his 2021 admission to CMHHIP. Drawing

on his 2021 and 2025 encounters with Gregor — both on and off

medication — Dr. Pillai opined that without medication, Gregor’s

mental condition would significantly deteriorate, leading to

increased delusional thinking, paranoia, agitation, and aggressive

behaviors. In his affidavit, admitted at trial, Dr. Pillai explained

that when Gregor was off medication or undermedicated, he had

screamed, postured, chased after CMHHIP staff, and made violent

threats including threatening to “whoop [a peer’s] ass” and “to

commit a homicide in this bitch.” The doctor opined that Gregor

needed the requested medications to prevent acute psychotic and

manic episodes, loss of control, and threatening behavior.

¶ 12 As to Gregor’s interest in refusing medication, Dr. Pillai

acknowledged that Gregor’s complaints amounted to a bona fide

and legitimate basis for refusal. However, he noted that Gregor had

5 no known underlying health conditions that would be adversely

affected by the medications, which he appeared to be tolerating

well. Dr. Pillai also noted that such side effects typically resolve

over time with continued use of the prescribed medications.

¶ 13 Based on this evidence, the district court found that Gregor’s

need for treatment outweighed his concerns about side effects and

concluded that the State had presented clear and convincing

evidence to support the fourth Medina element. Because ample

evidence supports the district court’s findings and conclusion, we

perceive no error. See People in Interest of A.J.L., 243 P.3d 244, 255

(Colo. 2010).

III. Disposition

¶ 14 The order authorizing the involuntary administration of

medication is affirmed.

JUDGE FREYRE and JUDGE YUN concur.